Uganda Confirms 1 Death From Ebola-like Marburg Virus

Last Updated: October 19, 2017 10:40 AM

KAMPALA —

Uganda’s ministry of health confirmed Thursday that one person has died of Marburg hemorrhagic fever, a close relative of the Ebola virus. Surveillance teams have deployed to the affected district in the eastern part of the country to contain the outbreak.

Uganda’s Ministry of Health says one of the two suspected cases of Marburg virus disease has been confirmed via laboratory tests conducted by the Uganda Virus Research Institute.

“The confirmed case was a 50-year-old female from Chemuron village, Kween District in Eastern Uganda. She presented with signs and symptoms suggestive of a viral hemorrhagic fever," said Dr. Jane Ruth Aceng, the minister for health. "Preliminary field investigations indicated that prior to her death, the deceased had nursed her 42-year-old brother, who had died on September 25, 2017 with similar signs and symptoms."

According to the World Health Organization, Marburg is transmitted via contact with the bodily fluids of an infected person or the handling of infected animals. Local media report that the deceased woman’s brother was a hunter.

The Ministry of Health has dispatched a rapid response team to the Kween district.

“As of this morning, because their surveillance obviously started from the hospitals where the confirmed case passed away, we have ten health workers who have been listed as contacts, and they have already been isolated in their homes for follow up,”Aceng said.

Uganda is no stranger to viral hemorrhagic fever. The country has battled several outbreaks of Ebola, including an outbreak in 2000 that killed over 200 people.

Marburg is named after the town in Germany where it was first identified in 1967, though that outbreak was traced back to infected monkeys brought from Uganda.

“We have the caves that have the bats that are capable of transferring infection to man in different parts of the country. You can never know when the next outbreak will be. It depends on when man interacts with an infected bat from one of these caves,” said Dr. Miriam Nanyunja , the disease prevention and control officer for the WHO in Uganda.

A person suffering from Marburg presents with sudden onset of high-level fever and headache. This can be accompanied by vomiting, joint and muscle pain, and unexplained bleeding.

There is no cure or vaccine available for Marburg. Patients are given supportive treatment to increase their chance of survival.

Ebola-like Marburg virus kills two in Uganda: official

October 19, 2017

Two people have died from the Marburg virus in eastern Uganda, in the country's first outbreak of the deadly Ebola-like pathogen in three years, the health ministry said Thursday.

"Blood samples were taken from two people who have since died and were found positive for Marburg", Uganda'shealth ministry permanent secretary, Dr. Diana Atwine told AFP.

She said a team of experts had been sent to Kween district, near the Kenyan border, to contain the virus.

"At moment we don't know if there are other people apart from the dead who have contracted the disease because the health experts are still investigating in addition to sensitising the population about the dangers of Marburg and we call for public vigilance," she added.

One individual was a male hunter who died on September 25. His 50-year-old sister died on October 11.

"The second victim had taken care of her brother during his sickness and burial preparation rituals when we suspect she contracted the disease," Health Minister Ruth Achieng said.

The two are the first recorded cases of Marburg in Kween district.

According to the Uganda Virus Research Institute, the first known case of Marburg in the country was in the western district of Kamwenge in 2007.

A 2012 outbreak killed 10 people and in 2014 one man died.

The Marburg virus is one of the most deadly known pathogens. Like Ebola, it is a haemorrhagic fever—it causes severe bleeding, fever, vomiting and diarrhoea. It has a 21-day incubation period.

Like Ebola, the Marburg virus is also transmitted via contact with bodily fluids and fatality rates range from 25 to 80 percent.

The name of the disease comes from the city of Marburg in central Germany, where the virus was first identified in 1967 among workers who had been exposed to infected African green monkeys at a research lab.

Marburg virus disease

Intensive social mobilization was key in controlling Marburg outbreak in Uige, Angola 2005.

Marburg virus disease (MVD) (formerly known as Marburg haemorrhagic fever) was first identified in 1967 during epidemics in Marburg and Frankfurt in Germany and Belgrade in the former Yugoslavia from importation of infected monkeys from Uganda. MVD is a severe and highly fatal disease caused by a virus from the same family as the one that causes Ebola virus disease. These viruses are among the most virulent pathogens known to infect humans. Both diseases are rare, but have a capacity to cause dramatic outbreaks with high fatality.

Illness caused by Marburg virus begins abruptly, with severe headache and severe malaise. Many patients develop severe haemorrhagic manifestations between days 5 and 7, and fatal cases usually have some form of bleeding, often from multiple sites. Case fatality rates have varied greatly, from 25% in the initial laboratory-associated outbreak in 1967, to more than 80% in the Democratic Republic of Congo from 1998-2000 and the outbreak in Angola in 2005.

The Marburg virus is transmitted by direct contact with the blood, body fluids and tissues of infected persons. Transmission of the Marburg virus also occurred by handling ill or dead infected wild animals (monkeys, fruit bats). The predominant treatment is general supportive therapy

20 OCTOBER 2017 | GENEVA -WHO is working to contain an outbreak of Marburg virus disease (MVD) that has appeared in eastern Uganda on the border with Kenya.

At least one person is confirmed to have died of MVD and several hundred people may have been exposed to the virus at health facilities and at traditional burial ceremonies in Kween District, a mountainous area 300 kilometres northeast of Kampala.

The first case was detected by the Ministry of Health on 17 October, a 50-year-old woman who died at a health centre of fever, bleeding, vomiting and diarrhoea on 11 October. Laboratory testing at the Uganda Virus Research Institute (UVRI) confirmed the cause of death as MVD.

The woman’s brother had also died of similar symptoms three weeks earlier and was buried at a traditional funeral. He worked as a game hunter and lived near a cave inhabited by Rousettus bats, which are natural hosts of the Marburg virus.

One suspected and one probable case are being investigated and provided with medical care. An active search for people who may have been exposed to or infected by the virus is underway.

The Ministry of Health has sent a rapid response team to the area supported by staff from the World Health Organization, the Centers for Disease Control and Prevention (CDC) and the African Field Epidemiology Network (AFNET).

WHO is providing medical supplies, guidance on safe and dignified burials, and has released USD 500 000 from its Contingency Fund for Emergencies to finance immediate response activities.

“We are working with health authorities to rapidly implement response measures,” said Ibrahima-Soce Fall, WHO Regional Emergency Director for the Africa region. “Uganda has previously managed Ebola and Marburg outbreaks but international support is urgently required to scale up the response as the overall risk of national and regional spread of this epidemic-prone disease is high.”

Marburg virus disease is a rare disease with a high mortality rate for which there is no specific treatment.

Notes to editors

Marburg virus disease (MVD) is a severe and highly fatal disease caused by the Marburg virus from the Filoviridae family; the same family as the Ebola virus. This virus is among the most virulent pathogens known to infect humans. The incubation period is 2-21 days, and symptom onset is sudden and marked by fever, chills, headache, and myalgia. Although MVD is rare, it can result in large outbreaks with high case fatality rates (CFR range from 23 to 90%). The disease is transmitted by direct contact with the blood, body fluids and tissues of infected persons or wild animals (e.g. monkeys and fruit bats).

In Uganda, the following MVD outbreaks have been recently documented:

2007: 4 cases, including 2 deaths, in Ibanda District, Western Uganda

2008: 2 unrelated cases in travelers returning to the Netherlands and USA, respectively after visiting caves in Western Uganda

2012: 15 cases, including 4 deaths, in Ibanda and Kabale districts, Western Uganda

WHO Handles Outbreak of Marburg Virus in Uganda

Kampala, Oct 22 (Prensa Latina) The World Health Organization (WHO) is handling, along with local authorities, an outbreak of the Marburg virus disease (MVD) in an eastern area of Uganda bordering Kenya, said today the media in the region.

'We are working with health authorities to rapidly implement response measures,' said Ibrahima-Soce Fall, WHO Regional Emergency Director for the African region, quoted by Africanews.

'Uganda has previously managed Ebola and Marburg outbreaks but international support is urgently required to scale up the response as the overall risk of national and regional spread of this epidemic-prone disease is high,' said Fall.

WHO specialists confirmed that one person was killed by MVD, which is similar to the deadly Ebola virus that claimed 11,332 lives from 2013 to 2016 in West Africa and spread across three continents.

WHO estimates that the first case was a 50-year-old woman detected by the Ministry of Health on October 17th who died of fever, bleeding, vomiting and diarrhea, as laboratory testing at the Uganda Virus Research Institute (UVRI) confirmed the cause of death as MVD.

The woman's brother, who worked as a hunter and lived near a cave inhabited by Rousettus bats, natural hosts of the Marburg virus, had also died of similar symptoms three weeks earlier and was buried at a traditional funeral.

Specialists fear that several hundred people may have been exposed to the virus at health facilities and at traditional burial ceremonies in Kween District, a mountainous area 300 kilometers northeast of Kampala.

Two suspected cases are being investigated and provided with medical care by health authorities, while an active search for people who may have been exposed to or infected by the virus is underway.

Meanwhile, the Ministry of Health has sent a rapid response team to the area supported by staff from the World Health Organization, the Centers for Disease Control and Prevention and the African Field Epidemiology Network.

WHO is providing medical supplies, guidance on safe burials and has released $500,000 USD from its Contingency Fund for Emergencies to finance immediate response activities.

The Marburg virus disease is a rare disease with a high mortality rate and there is no specific treatment for it.

After various tests, the Ugandan authorities confirmed last October 19th the existence in the country of MVD, discovered in Marburg, a German city after which it was named.

Marburg virus disease – Uganda

Disease outbreak news25 October 2017

On 17 October 2017, the Ugandan Ministry of Health notified WHO of a confirmed outbreak of Marburg virus disease in Kween District, Eastern Uganda. The Ministry for Health officially declared the outbreak on 19 October 2017.

As of 24 October, five cases have been reported – one confirmed case, one probable case with an epidemiological link to the confirmed case, and three suspected cases including two health workers.

Chronologically, the first case-patient (probable case) reported was a male in his 30s, who worked as a game hunter and lived near a cave with a heavy presence of bats. On 20 September, he was admitted to a local health centre with high fever, vomiting and diarrhoea, and did not respond to antimalarial treatment. As his condition deteriorated, he was transferred to the referral hospital in the neighbouring district, where he died the same day. No samples were collected. He was given a traditional burial, which was attended by an estimated 200 people.

The sister (confirmed case) of the first case-patient nursed him and participated in the burial rituals. She became ill and was admitted to the same health centre on 5 October 2017 with fever and bleeding manifestations. She was subsequently transferred to the same referral hospital, where she died. She was given a traditional burial. Posthumous samples were collected and sent to the Uganda Virus Research Institute (UVRI). On 17 October, Marburg virus infection was confirmed at UVRI by RT-PCR and it was immediately notified to the Ministry of Health.

The third case-patient (suspected case) is the brother of the first two cases. He assisted in the transport of his sister to the hospital, and subsequently became symptomatic. He refused to be admitted to hospital, and returned to the community. His whereabouts are currently not known though there is an ongoing effort to find him.

Two health workers who were in contact with the confirmed case have developed symptoms consistent with Marburg virus disease and are under investigation (suspected cases). Laboratory results to rule out Marburg virus disease are pending.

Contact tracing and follow-up activities have been initiated. As of 23 October, 155 contacts including 66 who had contact with the first case and 89 who had contact with the second case-patient have been listed in the two affected districts, including 44 health care workers. The number of family and community contacts is still being investigated.

Public health response

The Ugandan Ministry of Health has rapidly responded to the outbreak, with support from WHO and partners. A rapid response field team was deployed to the two affected districts within 24 hours of the confirmation.

To coordinate response activities, the National Task Force has convened, an Incident Management System (IMS) framework implemented with an Incident Manager appointed, a District Task Force has been established, and an emergency rapid response plan has been developed.

Marburg virus disease response activities have been initiated, including surveillance, active case search, contact tracing and follow-up, as well as monitoring within affected communities and healthcare centres.

Personal protective equipment has been deployed in the affected districts. Healthcare workers have been put on high alert and training sessions are planned, including a thorough review of infection prevention and control (IPC) protocols and capacity. An isolation facility is being prepared at the health centre and the hospital.

Training of teams for safe and dignified burials has been conducted in affected districts.

Community engagement and awareness campaigns are ongoing to reduce stigma, encourage reporting and early healthcare seeking behaviours, and acceptance of prevention measures. Information, education and communication materials and messages have been updated and are being produced.

International partners and stakeholders have been engaged at country level, and internationally to provide support and technical assistance for the response as needed. WHO has deployed additional staff, and six viral haemorrhagic fever (VHF) kits. Funding has been provided from the WHO Contingency Fund for Emergencies to ensure immediate support and scale up the response. WHO has alerted partners in the Global Outbreak Alert and Response Network (GOARN), and is coordinating international support for the response.

UNICEF is assisting with communication activities, and community engagement.

Médecins Sans Frontières has deployed to support setting up of treatment centres.

As of 24 October, five cases have been identified – one confirmed case, one probable case, and three suspected cases, and the outbreak remains localised. Ugandan health authorities have responded rapidly to this event, and measures are being rapidly implemented to control the outbreak. The high number of potential contacts in extended families, at healthcare facilities and surrounding traditional burial ceremonies is a challenge for the response. In addition, hospitalised cases were handled in general wards without strict infection control precautions, and one probable case refused to be hospitalised for a period of time.

The affected districts are in a rural, mountainous area located on the border with Kenya, about 300km northeast of Kampala on the northern slopes of Mount Elgon National Park. The Mount Elgon caves are a major tourist attraction, and are host to large colonies of cave-dwelling fruit bats, known to transmit the Marburg virus. The close proximity of the affected area to the Kenyan border, and cross-border movement between the affected district and Kenya and the potential transmission of the virus between colonies and to humans, increases the risk of cross-border spread.

These factors suggest a high risk at national and regional level, requiring an immediate, coordinated response with support from international partners. Tourism to Mount Elgon including the caves and surrounding areas should be noted and appropriate advice given and precautions taken. The risk associated with the event at the global level is low.

WHO advice

Human-to-human transmission of Marburg virus is primarily associated with direct contact with blood and body fluids, and Marburg virus transmission associated with provision of health care has been reported when appropriate infection control measures have not been observed.

Health-care workers caring for patients with suspected or confirmed Marburg virus should apply infection control precautions to avoid any exposure to blood and body fluids, and unprotected contact with possibly contaminated environment.

Surveillance activities, including contact tracing and active case search must be strengthened within all affected health zones.

Raising awareness of the risk factors for Marburg infection and the protective measures individuals can take to reduce human exposure to the virus, are the key measures to reduce human infections and deaths. Key public health communication messages include:

Reducing the risk of bat-to-human transmission arising from prolonged exposure to mines or caves inhabited by fruit bats colonies. During work or research activities or tourist visits in mines or caves inhabited by fruit bat colonies, people should wear gloves and other appropriate protective clothing (including masks).

Reducing the risk of human-to-human transmission in the community arising from direct or close contact with infected patients, particularly with their body fluids. Close physical contact with Marburg patients should be avoided. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. Regular hand washing should be performed after visiting sick relatives in hospital, as well as after taking care of ill patients at home.

Communities affected by Marburg should make efforts to ensure that the population is well informed, both about the nature of the disease itself to avoid community stigmatization, and encourage early presentation to treatment centres and other necessary outbreak containment measures, including burial of the dead. People who have died from Marburg should be promptly and safely buried.

WHO advises against the application of any travel or trade restrictions on Uganda or the affected area based on the current information available on this event. Travellers to the Mount Elgon bat caves are advised to avoid exposure to bats and contact with non-human primates, and, to the extent possible, to wear gloves and protecting clothing, including masks .

For further information on Marburg virus disease and prevention and control measures is available in the WHO Marburg virus disease factsheet.

Travellers to the Mount Elgon bat caves are advised to avoid exposure to bats and contact with non-human primates, and, to the extent possible, to wear gloves and protecting clothing, including masks .

(in other words, if you go there, don't order the bushmeat special in the pub! )

In Kween district, health officials managed to get a high risk contact who has been in hiding and was found to have developed Marburg-like symptoms.

This patient is a 38-year-old male, brother to the confirmed case and the probable case. Because of his close contact with the probable and confirmed cases, he was listed as a high risk contact. However, he refused review and follow-up by the contact tracing/surveillance team despite several attempts to do so. On the 24 Oct 2017, however, he accepted to speak to the contact tracing team which noted that he had developed Marburg – like symptoms. He was transported to the isolation unit with fever, body weakness, abdominal pain, loss of appetite, joint pains and history of vomiting blood while at home. Despite the tireless efforts from a dedicated case management team to revive this case, he unfortunately passed away earlier Thursday.

A blood sample picked from this patient was sent to Uganda Virus Research Institute and tested positive for Marburg Virus Disease.

The other suspect case is a 25-year-old female from a village called government lodge, Kawowo parish, in Kapchorwa district who presented with Marburg – like symptoms. She has since been isolated and a sample was collected for confirmation. A pregnancy test was done and is positive. Her condition is however stable.

The new probable case is a 23-year-old male from Toywo village, Western Division, Kapchorwa Municipality. He shared a ward and his bed was next to the deceased confirmed case. A blood sample was collected and the case is still under isolation at Kapchorwa hospital in stable condition. His lab results are expected by tomorrow.

The total number of contacts under follow up currently stands at 130, 85 from Kween, and 45 from Kapchorwa district. None of the contacts has developed symptoms to date.

As of Thursday, 32 out of the 77 contacts from Kapchorwa district had either completed the recommended 21 days after exposure, or are no longer being followed because the case they were exposed to turned out to be negative.

East Africa: WHO Releases $500,000 to Contain Plague, Marburg

By Aggrey Omboki

Kenya and Tanzania are among counties identified by the World Health Organisation as likely hotspots for the plague that has ravaged Madagascar and a recent Marburg virus disease outbreak in eastern Uganda.

So serious is the prospect of the Marburg Virus crossing over the border to Kenya that the WHO has released $500,000 to contain the epidemic.

WHO's latest update on the outbreak put Tanzania, South Africa, Seychelles, Ethiopia, Mauritius, La Réunion, Kenya, Comoros and Mozambique on notice for possible spread of disease because of trade and travel links with Madagascar.

Over the past three months, the plague has claimed 124 lives with 1,133 cases of infection in Madagascar, while two people have died from the Marburg virus in Uganda in the past week.

WHO says the disease first appeared in ports of Madagascar in 1898.

"The recent appearance in Madagascar of a strain of the plague microbe Yersinia pestis showing multiresistance to antibiotics is a matter of much concern and highlights the necessity for effective surveillance of the disease. This strain, isolated from a patient with bubonic plague, was resistant to all first-line antibiotics as well as major alternative drugs," says the document.

The Permanent Secretary in Tanzania's Ministry of Health, Community Development, Gender, Children and the Elderly, Dr Mpoki Ulisubisya, said Ebola, Marburg and Zika fever have not been diagnosed in the country.

On Thursday, Ugandan Health Minister Jane Aceng confirmed one case of the virus, saying a 50-year-old woman had died after doctors diagnosed the disease following a series of tests on the patient.

"Prior to her illness and subsequent demise, she had nursed her 42-year old brother who died on September 25 after falling sick with similar signs and symptoms," said Ms Aceng.

Kenya has put measures in place to protect the country from the disease outbreaks.

The Ministry of Health has intensified surveillance at all points of entry and within counties bordering eastern Uganda, including Busia, Bungoma, Trans Nzoia and West Pokot.

Travellers and crew members of vessels from the two countries must undergo screening and fill surveillance forms upon arrival in Kenya. Aircraft and ships from the two countries are being inspected for rodent and flea infestation.

Tanzania and Kenya are yet to report cases of plague this year but have experienced the epidemics before.

From 1980 to 1997, human plague was reported in Tanzania every year with 7,246 cases and 585 deaths. Kenya reported 393 cases and 10 deaths in 1979 which was the last major epidemic in the country. A total of 10 deaths occurred between 1980 and 1990.

Two teams from Médecins Sans Frontières (MSF) are currently intervening in eastern Uganda, supporting local health authorities and partner organisations in responding to an outbreak of Marburg hemorrhagic fever.

So far, three people died from the disease (one suspect case and two confirmed cases) on 25 September, 13 October and 26 October respectively. They all belonged to the same family. The first two cases died in Kapchorwa hospital, while the third case died in the treatment unit in Kween health centre.

MSF is focusing its intervention around case management, and support to contact tracing and mapping. In Kween, MSF has set up and is running a 10-bed treatment unit, and an MSF epidemiologist is helping local health authorities with contact tracing – listing and monitoring people who have been in contact with identified cases. In Kapchorwa, MSF, together with the Ministry of Health, is running a nine-bed treatment unit within the existing district hospital.

Marburg virus disease is similar to Ebola – early symptoms are not specific and include fever, headache, fatigue, nausea. Like Ebola, it can be lethal in up to 90 per cent of cases.

There is currently no officially-approved vaccine or treatment against the disease, as no product has currently completed its clinical research path. However, existing drugs have shown at least partial efficacy against other filoviruses, and their use in the frame of a compassionate use scheme is currently being investigated by MSF and local health authorities.

Published Thu, November 2nd 2017 at 00:00, Updated November 2nd 2017 at 10:33 GMT +3

Emergency screening for Marburg virus has kicked off at the Kenya-Uganda border in Turkana after two people died died of the disease in Uganda. The deaths occurred in Kween District in the Eastern side of Uganda that borders Kenya. The two, a male hunter and his 50-year-old sister who died in September and October respectively, tested positive for Marburg virus, according to health officials in Uganda.

Turkana County Health and Sanitation Executive Jane Ajele said Sh9.5 million had been set aside for the emergency response that targets all people arriving at the border from Uganda. “We have trained health officials to handle the situation, if any is reported... We have also raised surveillance along all possible entry points,” said Ms Ajele. She added that movement in and out of Uganda was a major concern. “Our pastoralists have been moving in and out of Uganda in search of pasture and water. We also have business people and travellers who come into the country from Uganda.

This means the border at Lokiriama is very busy and that is why heavy surveillance is ongoing there,” she said.

Game hunter A report by the World Health Organisation (WHO) indicated that “the first case-patient reported was a man in his 30s, who worked as a game hunter and lived near a cave with a heavy presence of bats. On September 20, he was admitted to a local health centre with high fever, vomiting and diarrhoea, and did not respond to anti-malarial treatment. “As his condition deteriorated, he was transferred to the referral hospital in the neighbouring district, where he died the same day. No samples were collected. He was given a traditional burial.

The sister of the first case-patient nursed him and participated in the burial rituals. She became ill and was admitted to the same health centre on 5 October 2017 with fever and bleeding manifestations,” says WHO. The report further stated she was transferred to the same referral hospital, where she died. She was given a traditional burial and posthumous samples were collected and sent to the Uganda Virus Research Institute where the Marburg virus infection was confirmed.

The brother of the first two is said to have assisted in transporting his sister to the hospital and had subsequently became symptomatic. “He refused to be admitted to hospital, and returned to the community. His whereabouts are currently not known though there is an ongoing effort to find him,” read the report in part. The report states two health workers who were in contact with the confirmed case have developed symptoms consistent with the virus. “Contact tracing and follow-up activities have been initiated.

As of October 23, some 155 contacts including 66 who had contact with the first case and 89 who had contact with the second case-patient have been listed in the two affected districts, including 44 health-care workers,” the report shows.

The Turkana alert comes just a day after a suspected case of the virus in Trans Nzoia County. Blood samples On Tuesday, health officials took blood samples from a local herbalist for testing after he came into contact with a Ugandan patient who showed symptoms of the virus. The test, however, returned negative results.

Uganda Marburg virus outbreak is contained: WHO

Comment by Technophobe: Generally, I have my doubts about the Daily Mail; they do love a scary headline, so they are prone to alarmist stuff. As this signals the end of the alarm, it is probably fully accurate.

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